That was 1995, he said, and here we are 16 years later. Although some work was done toward developing this new medical care economic measure following the 1995 report, most of the work focused on the main income poverty measure, culminating in the SPM that the Census Bureau, along with the Bureau of Labor Statistics (BLS), has undertaken.

One can question why, with the implementation of health care reform, a medical care economic risk measure is still needed—particularly because health care reform has the promise of expanded coverage, both public and private, increased subsidies for low-income and moderate-income households, the removal of preexisting conditions, the removal of annual and lifetime limits, and the availability of the bronze, silver, and gold benefit packages.

Oellerich emphasized that it will be a very important measure, especially now that health care reform is going into various stages of implementation. It can be used to monitor the increase or decline in the number of people at economic risk and to gauge the extent of people’s risk because of medical care needs that they cannot afford, even if they have enough income to meet their other basic needs.

Oellerich noted that the issues are related to defining risk, resources, and financial burden. In talking about risk, one is talking about a forward-looking measure, not a backward-looking one. That is the difficult part, he said. One can always look back and say, X percent of the population with an income of Y had medical expenses exceeding 10 or 20 percent of their household income or assets. Looking forward at risk is much more difficult. He concluded by reiterating that a lot of work has been done on the new income poverty measure, the SPM, and the medical care economic risk measure is a separate piece that needs similar effort to move forward.


Kathleen Short (Census Bureau) provided background on the development of experimental poverty measures and the SPM at the Census Bureau. She explained that the Census Bureau’s work on the SPM is heavily influenced by a document by the Interagency Technical Working Group (ITWG), Observations from the Interagency Technical Working Group (March 2010), which laid out some initial plans for how the Bureau would move forward with the SPM.

This document essentially endorsed the recommendations of the 1995 National Research Council (NRC) report Measuring Poverty: A New Approach. It also stressed that the new measure would not replace the official poverty measure and would not be used for resource allocation or program eligibility. It is intended to be a statistical measure of poverty. Without

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